Stroke in patients with left ventricular assist device (LVAD): who is at risk? : a retrospective observational study at a tertiary care center

Objectives: Stroke is a severe complication in patients with left ventricular assist
devices (LVAD), significantly affecting quality of life and potentially leading to
death. This study aimed to illustrate the clinical features, outcomes, and risk
factors associated with stroke in LVAD patients, with the goal of identifying
potential treatment targets.
Methods: In a study of 249 consecutive patientswho underwent LVAD implantation,
detailed evaluations were conducted regarding clinical characteristics, perioperative
management, cardiovascular risk factors, comorbidities, and brain imaging. The
etiology, treatment, and outcomes were subsequently assessed in individuals who
encountered a stroke.
Results: Eighty-three cerebrovascular events (CVE) occurred in 54/249 patients
during a median study period of 2.2 years (0.4–3.5) with 53 ischemic events and
22 intracranial hemorrhages (ICH). Early peri- or postoperatively CVE in context
to the LVAD implantation were identified in 31 patients. Competing risks
regression analysis revealed that postoperative dialysis was associated with
higher risk for CVE, considering death as competing risk event (HR 3.617;
95%-CI: 1.78–7.35; p 0.001). Modified Rankin Scale at outpatient visit did not
differ in early CVE [3 (IQR 2–5) vs. 3 (IQR2–4), p = 0.146]. Late CVE frequently
occurred during hospitalization for sepsis or in cardiac rehabilitation [n = 16/41
events (39%)]. Competing risk analysis treating death and heart transplantation
as competitors identified history of stroke as associated factor [HR 3.564;
95%-CI (1.67–7.169); p = 0.001]. Mortality was not associated with CVE [with
n = 27/54 (50%) vs. without CVE 94/195 (48.2%) p = 0.183].
TYPE Original Research
PUBLISHED 09 September 2025
DOI 10.3389/fcvm.2025.1591208
Frontiers